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Individual
WILLIAM WALLACE
Active
Individual
WILLIAM WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRAADC, PLPC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
6279
MO
101YP2500X
Professional Counselor
Primary
2013038285
MO
Other
Enumeration date
08/28/2013
Last updated
04/16/2015
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